Respiratory Examination Flashcards
What breed of dog is laryngneal paralysis more common in?
labrador retrievers
What might be risk factor for respiratory disease
obesity
What can you do if you have a cow in urgent respiratory distress with stridor noises (signs of upper airway problem)
open the trachea
What are some possible clinical signs of upper respiratory issues
Stertor
Stridor
Inspiratory dyspnea
submandibular lymph node enlargement
unilateral nasal discharge
cough elicited on laryngeal palpation
Is inspiratory dyspnea seen with upper or lower airway disease
upper
Is expiratory dyspnea seen with upper or lower airway disease
lower
What are the clinical signs of lower airways disease
-Expiratory dyspnea
-Abnormal lung auscultation and/or thoracic percussion
-bilateral nasal discharge
Do you typically see bilateral nasal charge is upper or lower airway disease
typically with lower airway disease but do not rule out upper if if you bilateral nasal discharge
increased respiratory rate due to hypoxemia, hypercapnia, metabolic acidosis, hyperthermia
tachypnea
labored breathing
term is often subjective, often included abnormal breathing pattern, nasal flaring, abduction of elbow, extension of head
dyspnea
tachypnea
increased respiratory rate due to hypoxemia, hypercapnia, metabolic acidosis, hyperthermia
dyspnea
labored breathing
term is often subjective, often included abnormal breathing pattern, nasal flaring, abduction of elbow, extension of head
What are potential causes of animal in respiratory distress
1) Upper airway obstruction- respiratory noise audible
2) Lower Airway obstruction- pronounced expiratory effort - abdominal effort
3) Pleural space disease- decreased/absent lung sounds
4) Pulmonary parenchymal disease- increased/abnormal lung sounds
What would you see on physical exam of an animal in respiratory distress due to upper airway obstruction
respiratory noise is audible
What would you see on physical exam of an animal in respiratory distress due to lower airway obstruction
Pronounced expiratory effort
What would you see on physical exam of an animal in respiratory distress due to pleural space disease
decreased or absent lung sound
What would you see on physical exam of an animal in respiratory distress due to pulmonary parenchymal disease
increased/ abnormal lung sounds
How do you clinical examine the respiratory system
1) Respiratory rate
2) Respiratory effort
3) Respiratory pattern
4) Respiratory pattern
5) Cough sneeze, rattle
6) Air flow
7) Nasal discharge
8) Sinus percussion
9) lymph nodes
10) Palpation and auscultation of trachea
11) Rebreathing exam
*Does not only consist of lung auscultation
T/F: respiratory evaluation only includes lung auscultation
False
1) Respiratory rate
2) Respiratory effort
3) Respiratory pattern
4) Respiratory pattern
5) Cough sneeze, rattle
6) Air flow
7) Nasal discharge
8) Sinus percussion
9) lymph nodes
10) Palpation and auscultation of trachea
11) Rebreathing exam
*Does not only consist of lung auscultation
What should you look for when evaluating the nostrils in a respiratory exam
1) Assess nostril for discharge (serous, epistaxis, mucopurulent)
-present or absent
-unilateral (Upper) or bilateral (Lower)
-quality of discharge
-odor of discharge
2) Assess nostrils for airflow
-Present of absent
What might be an exception to upper airway disease having unilateral nasal discharge
horse with guttural pouch mycoses might have hemorrhage and bilateral nasal epistaxis
What is a dynamic obstruction
a respiratory noise that only occurs during inspiration OR expiration
a dynamic obstruction is respiratory noise that only occurs during
inspiration or expiration
What is a fixed obstruction
a respiratory noise that occurs during inspiration and expiration
T/F: loudness can be used to grade the degree of obstruction
False- a loud noise does not mean it is a severe obstruction
What is the difference between stertor vs stridor
‘Stertor’ is noisy breathing which occurs rostral to the larynx. ‘Stridor’ is noisy breathing that occurs at the level of the larynx or caudal
What classical cause of a horse having an inspiratory and expiratory noise during exercise
laryngeal paralysis
altered vocalization typically caused by diseases that affect the vocal cords
abnormal phonation
vocal cord paralysis (CN X), inflammation, infection, physical deviations due to tumors, cysts, etc
what is often one of the earliest signs of vocal cord disease
altered phonation
When does cyanosis occur
Un-oxygenated hemoglobin (>5g/dL)
O2 saturation <80%
PaO2 <40mmHg
What are the only lymph nodes that can be easily palpated in the healthy horse
Submandibular lymph nodes- located at the intramandibular space
*The retropharyngeal lymph nodes may be palpated if enlarged
Submandibular lymph nodes- located at the intramandibular space are the only lymph nodes that can easily be palpated in the healthy horse, but what else can you palpate if they are enlarged
the retropharyngeal
What is the importance of palpating the (sub)mandibular lymph nodes for respiratory examination
lymph nodes get antigens from the head, oral cavity, nasal cavity, eyelids, and paranasal sinuses.
can help tell you possible causes
What is the importance of paranasal sinus percussion in large animals
you want to compare the resonance on both sides and if the horse seens painful
also want to see how the animal responds? are they painful from this pressure
*Is it fluid filled (dull) or air filled (hollow) sounding
Why is it important to percuss the caudal maxillary sinus in a horse
sinusitis commonly affects this sinus because of tooth root problems of the last premolar and molar
What is the most common place for a cow to develop sinusitis
Frontal sinus
*dehorning or horn problems
How should you examine the larynx
1) Palpate dorsal aspect of larynx noting any asymmetry
2) Palpate retropharyngeal area for retropharyngeal lymph node enlargement
3) Slap test (horse): put finger around larynx of horse and slap withers to elicit a twitch of the musculature
4) Try to elicit a cough- squeeze trachea after larynx and if they cough there is some degree of laryngeal sensitivity
What is the slap test of the horse?
Slap test (horse): put finger around larynx of horse and slap withers to elicit a twitch of the musculature
tests recurrent laryngeal nerve (CN X)
What is the significance of trying to elicit a cough during a respiratory exam
Try to elicit a cough- squeeze trachea after larynx and if they cough there is some degree of laryngeal sensitivity
How should you examine the trachea
1) palpate the trachea for any abnormalities such as irregular cartilage rings or fractures
2) Auscult the trachea for any abnormal sounds (mucous rattles)
Why might an animal have subcutaneous emphysema
caused by disruption of the respiratory tract distal to the larynx
e.g tracheal rupture or perforation, penetrating foreign body, iatrogenic
caused by disruption of the respiratory tract distal to the larynx
e.g tracheal rupture, penetrating foreign body, iatrogenic
subcutaneous emphysema
What is a normal breathing pattern
Costoabdominal breathing
respiratory effort is split equally betwee the chest and abdomen
Costoabdominal breathing
respiratory effort is split equally betwee the chest and abdomen
*normal breathing
What might be happening if the animal has increased thoracic effort of breathing
pain the abdomen
What might be happening if the animal has increased abdominal effort of breathing
lost of elasticity of lungs
Normally, the breathing pattern is split between chest and abdominal efforts. What happens if this isnt equal
Increased Thoracic effort: pain the abdomen
Increased abdominal effort: lost of elasticity of lungs
What might be happening if a horse has increased abdominal effort (recruitment of accessory muscles during expiration)
some sort of lost of elasticity of lungs
*Increased expiratory
chronically might result in heaves line due to hypertrophy of abdominal muscles
What might be happening if you see a cat that has increased abdominal effort and restrictive breathing pattern
reduced chest wall/ lung compliance having to use abdominal muscles to breathe
pleural effusion?
Breath sounds are created by
turbulent airflow
occurs when high velocity flow passes through a large diameter airway
when is laminar breath flow generated
occurs in low flow situation (small airways <2mm)
not enough air movement to generate turbulent sound
When is turbulent airflow generated
occurs when high velocity flow passes through a large diameter airway
Airflow turbulence is determined by
1) Airflow velocity
2) Airway lumen architecture
What increases the airflow turbulence
1) Decreases in the cross sectional area (at equal volume) increases airflow. velocity
2) Irregular lumen architecture: increases airflow turbulence
How should you auscultate at rest
-Compare sounds in ventral, dorsal, and mid thorax
-Compare sounds ausuculted in the left and right thorax
-Compare lung osunds to tracheal sounds
What is the purpose of a rebreathing exam
uses a plastic bag around nose in horses
allows auscultation of subtle airway sounds because the horse will begin to breathe more heavily and the sounds will become more apparent
allows assessment of recovery time
allows assessment of coughing
What does the intensity of breathe sounds depend on
1) Amount of turbulence (airflow velocity and airway lumen architecture)
2) Acoustic characteristics of tissue
3) Thickness of tissue
During tracheal breath sounds, you hear
inspiratory and expiratory sounds are equal (very loud and high pitch)
*over the trachea
During bronchial breath sound, you hear
inspiratory sound is shorter than the expiratory (loud, relatively high pitch)
During bronchovesticular breath sounds, you hear
inspiratory and expiratory sounds are equal (medium loudness, intermediate pitch)
*first and second intercostal spaces next to sternum
*same as tracheal but not as loud because it has to travel through more tissue
During vesticular breath sounds, you hear
inspiratory sound is longer than the expiratory sound (soft, relatively low pitch)
most of the lung field
What are factors of impaired sound transmission during a respiratory exam
1) Extrapulmonary factors
a) chest deformities
b) Obesity
2) Intrapulmonary factors
a) Disrupted mechanical properties of lung (emphysema)
b) Addition of medium between lung and sthethoscope (air, fluid, masses)
What might be extrapulmonary factors of impaired sound transmission
a) chest deformities
b) Obesity
What might be intrapulmonary factors of impaired sound transmission
a) Disrupted mechanical properties of lung (emphysema- more air in tissue)
b) Addition of medium between lung and stethoscope (air, fluid, masses)
How does lung consolidation affect lung sounds
Normally the lung is aerated where sound must move through multiple air-tissue interfaces
however, when the lung is consolidated with patent airways, there are fewer air-tissue interfaces leading to less attenuation and increased intensity
when there is consolidated lung with blocked airways, there is loss of breathe sounds
How does consolidated lungs affect airsounds
when the lung is consolidated with patent airways, there are fewer air-tissue interfaces leading to less attenuation and increased intensity
when there is consolidated lung with blocked airways, there is loss of breathe sounds
What are adventitious lung sounds
additional respiratory sounds superimposed on normal breathe sounds
1) Wheeze
2) Crackles
3) Stridor
4) Pleural friction rub
5) Squawk
What are the 5 adventitious lung breathe sounds
1) Wheeze (continuous, melodic, high or low pitch)
2) Crackles (interrupted, musical, high or low pitch)
3) Stridor (continuous or interrupted, musical, high pitch)
4) Pleural friction rub (interrupted, non-musical)
5) Squawk (mixed sounds- short wheeze, squeak)
turbulent flow through narrowed segment of the upper respiratory tract
*inspiratory
Stridor
What is Stridor
turbulent flow through narrowed segment of the upper respiratory tract
*inspiratory
Stridor that originates from the airway rostral to larynx
Stertor
long and musical sound
high or low pitched
may be expiratory or inspiratory
due to narrowing of airway
Wheezes
noise that results from vibration of the pharyngeal tissues (nasopharynx, oropharynx, soft palate) due to significant upper respiratory obstruction and subsequent turbulent airflow downstream in the upper airway. This is a noise heard only on inspiration.
Stertor
What produces the wheezes sound
narrowing of the airway
T/F: wheezes are only heard during expiratory
false- may be heard due inspiration or expiration
short, explosive, nonmusical heard on inspiration due to sudden inspiratory opening of small airways
Crackles
When are crackles heard
due to sudden inspiratory opening of small airways
How do you perform thoracic percussion
place middle finger in the intercostal space and knock finger against chestwall. Do you hear differences between the top or bottom (where fluid might be in the pleural space)
can also use spoon and hammer
normal lung: clear, moderate intensity, low pitch
Is thoracic percussion the most sensitive technique to detect fluid in the chest?
No- ultrasound is the best method
What would trapped air (eg. pneumothorax) sound like on thoracic percussion
clear quality, loud intensity, low pitch
What would solid tissue (eg. pleural effusion consolidation or mass) sound like on thoracic percussion
dull quality, soft intensity, high pitch
Airflow turbulence (cause of breath sounds) are determined by
1) Airflow velocity
2) Airway lumen architecture
